There is no typical protocol for the management of scalp and/or cranial vault lesions. Many lesions are amenable to surgical resection by means of variable operative techniques with or without additional reconstructive procedures. As reported in the neurosurgical literature, it appears that most case reports of scalp and/or calvarial lesions are still managed on an individual decision basis depending on the results of appropriate clinical presentation, nature of the lesion, and treatment objective. In this perspective, collaboration with craniofacial and plastic surgeons has markedly improved reconstruction results. In this chapter, various surgical therapy options for lesions of the scalp and the cranial vault as described.